Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane Block versus Laparoscopic Intraperitoneal Instillation of Local Anesthetic in Pediatrics Undergoing Inguinal Hernia Repair: A randomized Controlled Trial

Document Type : Original Article

Authors

1 Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Tanta University, Tanta, Egypt.

2 Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Helwan University, Helwan, Egypt.

3 Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.

Abstract

Background: Significant pain and discomfort post inguinal hernia repairing surgeries are often reported in surgical units concerning pediatrics. In this trial, we compared the analgesic effects of ultrasound-guided transversus abdominis plane block [UTAPB], laparoscopic guided transversus abdominis plane block [LTAPB], and laparoscopic intraperitoneal instillation [IPIN] of local anesthetic [LA] for pediatrics undergoing laparoscopic inguinal hernia repair [LIHR].
Patients and Methods: This randomized trial included 66 pediatrics aged between two months and seven years and planned for LIHR. They were divided into three equal groups: a control group received UTAPB, a second group received LTAPB, and a third group received IPIN of LA into the peritoneal cavity. Each block was administered using a standardized dose of 1 ml/kg bupivacaine 0.25% with 20 mL maximum volume. The primary outcome was pethidine consumption in the first 24 hours after surgery.
Results: UTAPB and LTAPB groups had significantly lower total pethidine consumption compared to the IPIN of LA group [p < 0.001], with a significantly longer time to first rescue analgesia [p < 0.001]. Pain scores at 2, 4, and 6 hours after surgery were significantly lower in the UTAPB and LTAPB groups than in the IPIN of LA group [p < 0.05]. No significant variances were noted in postoperative pain scores, time to rescue analgesia, and overall pethidine consumption between the UTAPB and LTAPB groups.
Conclusion: In children undergoing LIHR, both UTAPB and LTAPB were found to be more effective than IPIN of LA in decreasing pain scores, delaying the need for rescue analgesia, and decreasing overall opioid use during the initial 24 hours after operation, with comparable analgesic effect between UTAPB and LTAPB.

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